Having kissing disease infection, more commonly known as “mononucleosis” or “mono” during childhood and adolescence may increase the risk for developing multiple sclerosis (MS) later in life, new research says.
According to the CDC, at least one in every four EBV-infected teenagers and young adults will develop mono.
The research, published in the medical journal JAMA Network Open, revealed that a mono-infection during teenage years was associated with the development of MS after the age of 20, regardless of shared family factors or genetic risk.
According to the paper, infectious mononucleosis (IM) is an acute viral infection that is also known as glandular fever or the “kissing disease” because it is communicated by bodily fluids, particularly saliva. Although the Epstein-Barr virus (EBV) is the most prevalent cause of IM, other viruses can also cause it.
According to the study’s authors, adolescence may be “an important period of susceptibility” in starting a relationship between IM and MS because this group is more likely to be exposed to environmental conditions that can lead to mono infection.
“Because MS may have an asymptomatic or prodromal period of approximately 5 to 10 years before clinical onset, a diagnosis of IM in adolescence could potentially signal that IM is a consequence of prodromal MS,” said the study’s authors.
Researchers from Sweden’s Orebro University examined hospital-diagnosed cases of mono during childhood (birth to 10 years of age), adolescence (11-19 years of age), and young adulthood (20-24 years of age), as well as subsequent MS diagnosis.
The team assesed nearly 2.5 million people born in Sweden between 1958 and 1994, and volunteers aged 20 years were followed up with every 15 years from 1978 through 2018 for subsequent MS diagnosis.
According to the study, 5,867 (0.24 percent) of the 2,492,980 participants studied had an MS diagnosis after the age of 20, with the median age of diagnosis being 31.
“There were associations observed between infectious mononucleosis in childhood and adolescence and an increased risk for an MS diagnosis. This association remained significant after controlling for shared familial factors,” said the study.
The study does indicate, however, that after accounting for family genetics, there was no significant connection between mono infection in early adulthood and eventual MS diagnosis.
This “age-defined pattern of risk,” according to the researchers, may represent heterogeneity in susceptibility to infection exposures as the immune system develops and changes over adolescence.
The research had some limitations, such as the inability to include patients who were only diagnosed and treated in primary care, and hospital-based outpatient diagnoses were not accessible until 2001. According to the authors, this most likely resulted in a selection of “more severe acute manifestations of the infection.”
According to the study, some IM and MS diagnoses may be missing as a result of insufficient nationwide coverage for hospital registrations before 1987, as well as the lack of outpatient information prior to 2001.
While the IM infection is not a risk factor for MS, the study’s authors believe it could assist identify those who are more likely to get MS later in life.
“Our findings lend further weight to the notion that Epstein-Barr virus plays a role in pathogenesis, where the pattern of exposure and acute manifestation of the infection are relevant, rather than being a bystander phenomenon due to MS disease activity or susceptibility to MS resulting in a greater likelihood of IM,” concluded the study authors.
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